Is NOTES mesh placement safe? Results of a randomized blinded trial comparing NOTES and laparoscopy

Background: Ventral hernia repair with mesh is a frequently performed procedure and the Natural Orifice Translumenal Endoscopic Surgery (NOTES) concept might be adaptable for hernia repairs avoiding incision in the abdominal wall. The risk for infection in mesh placement is of concern. We compared abdominal wall mesh placement via NOTES with the laparoscopic mesh placement.
Hypothesis: Transgastric mesh placement will be feasible. There will be no difference in the mesh infection rate between animals undergoing mesh placement with NOTES versus laparoscopic mesh placement
Design: Randomized blinded trial using permuted block design
Setting: Experimental surgery in a porcine survival model
Methods: 18 swine were randomized to abdominal wall polypropylene mesh placement via NOTES or laparoscopy. All animals received pre-operative antibiotics and gastric irrigation. In the NOTES group, the 1 x 2 cm mesh was transported into the abdominal cavity via a protective but not entirely sealed transgastric transportation device and clipped to the anterior abdominal wall. The animals randomized to laparoscopy underwent initial upper endoscopy (no gastrotomy) followed by a 10 min washout period and then laparoscopic mesh placement. Postoperatively clinical data and WBC were collected, necropsy, peritoneal and mesh cultures performed at 14 days. Data analysis was performed using the chi2-test. IACUC approval was obtained for the study.
Results: All but one procedure were successfully completed. One NOTES experiment was incomplete due to instrumentation failure (endoscope). All animals survived to 14 days. At necropsy significantly more clinical mesh infections with localized abscesses were noted in the NOTES mesh group versus the laparoscopy group (p

Session: Poster

Program Number: P229

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